Question :

Menisco Capsular Separation: What is it? And what to expect.

Dear Ask The Doctor:
I have a question about a diagnosis I was given... A little about me. I am a 26 year old male who is in pretty good shape. I go to the gym daily. On November 27, 2009 I had a real bad fall and twisted my knee real good. I wasn't able to move my knee for a week it had swollen pretty good and hurt to move or bend it. On Jan 5, 2010 I went to see an ortho surgeon about it since it hadn't gotten better. I can now walk just fine on it but if I try to run or twist my knee is still hurts. Doc told me to get an MRI. MRI results come back as a meniscocapsular separation with strain through out the medial part of the knee. Jan 20, 2010 See Ortho again, before he comes in the room I hear him talking to someone and hear him say, "meniscocapsular separation." Doc walks into the room and then tells me I have a grade 2 MCL tear??? and to give it another month and it should get better. Well it's now Feb 20, 2010 and nothing has changed, knee still hurts in the same place. Knee pops a lot and if I keep it bent it locks up and I have to "WORK" it back straight. 1- What is a meniscocapsular separation? 2- Is it time to go to a new doctor? 3- I feel I am getting the run around since I have no insurance and I am paying in cash and a college student. Am I lower on the list and is just doesn't want to deal with me? Thanks a bunch, I don't want to keep going back for office visits just to pay $100 to have him tell me come back in another month.


Answer :

Dear Patient: 
Meniscal injuries are a common problem in sports and in young active individuals; they are the most frequent injury to the knee joint. The menisci are C -shaped fibrocartilaginous structures attached to the tibia and their main functions to enhance the contact between the two articular surfaces of the knee: femur and tibia ones. The thick outline of menisci allows for a firm attachment to the joint capsule.
According to your MRI, the lesion is located in your medial (internal, inner part of the knee) meniscus (MM) and the attachment of the MM to the joint capsule is more rigid than that of the Lateral Meniscus (the outer one), making the MM more susceptible to injury and higher stresses. The medial meniscus also acts secondarily to provide anteroposterior stability, and then when an injury occurs there is a greater chance that affects also the Anterior Cruciate ligament (ACL) and/or the Meniscus lateral (ML), this seems to be your particular case: a capsular separacion of the medial meniscus associated with a grade 2 anterior cruciate ligament tear.
The MRI is the most accurate imaging study to diagnose this kind of lesions. It is common the clicking, the locking and the pain in the affected knee.
Spontaneous healing is common because of the rich blood supply in the meniscal periphery. Successful recovery from a meniscal tear is helped by a gradual resolution of symptoms over 6 weeks with a return to normal activity by 3 months. Many meniscal tears heal spontaneously. Also, can be treated with casting depending of the severity of the tear. With time the symptoms can improve.


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